Amenorrhoea Flashcards
What is primary amenorrhoea?
Never menstruated, with or without secondary sexual characteristics
What can cause primary amenorrhoea?
Imperforate hymen
Delay in puberty
Gonadal dysgenesis
Androgen insensitivity syndrome
When can primary amenorrhoea be diagnosed?
Age 14 with no secondary sexual characteristics
Age 16 with secondary sexual characteristics
What investigations are done for primary amenorrhoea?
FSH, LH, prolactin, TSH, testosterone, oestrogen
Pelvic US
Progesterone withdrawal bleed test
What is the management of primary amenorrhoea?
Monitor
Dependent on cause- e.g. puberty induction
How is puberty inducted?
Gradual build up with oestrogen
Add progesterone once full height potential reached
What are the features of imperforate hymen?
Primary amenorrhoea and not sexually active
Cyclical pain and bloating but no blood
What is secondary amenorrhoea?
More common
Previously has had periods, but none for >6 months
What are the causes of secondary amenorrhoea?
Pregnancy/breastfeeding Menopause Tyroid disease Hyperprolactinaemia Low body weight Stress Excessive exercise PCOS Cushing's Sheehan's Asherman's
What is Sheehan’s?
Pituitary failure after massive PPH
What is Asherman’s syndrome?
Intrauterine adhesions
Complications of dilatation and curettage for miscarriage
What investigations are done for secondary amenorrhoea?
Pregnancy test BP and BMI Exam Bloods Pelvic US
What bloods are done for secondary amenorrhoea?
FSH, LH
Oestradiol, testosterone
Prolactin
TFTs
